CCP Self-Management Goal Setting 2 — Questions and Answers
Question 1: A patient with type 2 diabetes sets a goal to 'exercise more.' What is the best next step for the care manager?
- Document the goal as stated
- Help the patient make the goal time-bound and specific (Correct answer)
- Suggest the patient consult a fitness trainer
- Refer the patient to a diabetes educator
Correct answer: Help the patient make the goal time-bound and specific
Vague goals like 'exercise more' must be refined into SMART goals with specifics like frequency, duration, and a timeline.
Question 2: Which technique is MOST effective for uncovering a patient's intrinsic motivation during goal-setting?
- Providing a list of recommended goals
- Using open-ended motivational interviewing questions (Correct answer)
- Administering a standardized health risk assessment
- Explaining the clinical consequences of inaction
Correct answer: Using open-ended motivational interviewing questions
Motivational interviewing with open-ended questions helps patients articulate their own reasons for change, which are more sustainable than externally imposed goals.
Question 3: A care manager asks a patient to rate their confidence in achieving a goal on a scale of 0–10. What is the purpose of this technique?
- To document the patient's health literacy level
- To identify the patient's readiness and potential barriers (Correct answer)
- To assign a risk stratification score
- To compare the patient to population benchmarks
Correct answer: To identify the patient's readiness and potential barriers
Confidence rulers assess self-efficacy and reveal barriers that may need to be addressed before the patient can succeed with the goal.
Question 4: When a patient achieves a self-management goal, the care manager should PRIMARILY:
- Immediately set a more challenging replacement goal
- Acknowledge the success and collaboratively identify the next goal (Correct answer)
- Reduce the frequency of follow-up contacts
- Transfer the patient back to their primary care provider
Correct answer: Acknowledge the success and collaboratively identify the next goal
Acknowledging success reinforces self-efficacy, and collaborative goal-setting maintains momentum and patient engagement.
Question 5: A patient with COPD wants to reduce breathlessness during daily activities. Which self-management goal is MOST appropriate as an immediate first step?
- Run a 5K race within six months
- Practice pursed-lip breathing for 5 minutes twice daily this week (Correct answer)
- Eliminate all physical activity until symptoms resolve
- Schedule a pulmonary function test
Correct answer: Practice pursed-lip breathing for 5 minutes twice daily this week
Pursed-lip breathing is a manageable, evidence-based technique that directly addresses breathlessness and builds the patient's confidence.
Question 6: Which of the following BEST describes the role of action planning in self-management goal setting?
- Action plans are created by the clinician and handed to the patient
- Action plans translate broad goals into specific weekly behavioral steps (Correct answer)
- Action plans focus on long-term outcomes over 1–2 years
- Action plans replace the need for follow-up visits
Correct answer: Action plans translate broad goals into specific weekly behavioral steps
Action plans break broad goals into specific, short-term steps (typically weekly) that the patient commits to completing.
Question 7: A patient repeatedly fails to meet self-management goals. The FIRST action the care manager should take is:
- Notify the patient's insurance company of non-compliance
- Explore potential barriers with the patient in a non-judgmental manner (Correct answer)
- Discontinue goal-setting until the patient shows motivation
- Lower all future goals to the easiest possible tasks
Correct answer: Explore potential barriers with the patient in a non-judgmental manner
Exploring barriers collaboratively and non-judgmentally helps identify the root causes of difficulty and adjust the plan accordingly.
CCP Self-Management Goal Setting 2
A patient with type 2 diabetes sets a goal to 'exercise more.' What is the best next step for the care manager?